Rethinking Medications in the Age of Genetic Testing

What would you do if you were told that one of your go-to medicines for mild to moderate days was something you shouldn’t take because of your specific genetics? None of us wants to have that happen. Living with chronic illness means constantly looking for another medicine or treatment to add to our migraine toolkit, not looking to take something out of it.

Of course, we have to remove things sometimes. We get serious or intolerable side effects. The treatment or medicine doesn’t work, or it does but then it stops working. We develop interactions between it and something else we’re taking or doing.

We’re used to these types of removals. We’ve learned to expect them. But what if we’re told to remove a particular drug – one that’s working at least sometimes, at least on the milder days – because our specific genes make it more likely that we’ll experience serious side effects? Even if those side effects haven’t happened yet?

Silent problems with a common drug

My go-to mild pain reliever has always been ibuprofen. I don’t take acetaminophen. It doesn’t work well for me, and I don’t consider the liver risks worth the small to no benefit I receive from taking it. I don’t take any medications with it included, either. Even the opioids I’ve prescribed for my severest days have the acetaminophen removed.

Ibuprofen was my first neurologist’s abortive of choice as well. None of the triptans have been beneficial for me, so in the early days of my diagnosis, she told me to take three to four of the liquid ibuprofen capsules at onset (because my migraines come on severely and rapidly). I would tally the number of days I’d taken medications each month, making sure not to go into what would be considered a risk factor for MOH, and I’d treat the ones I needed to treat just as she said.

It turns out I wasn’t supposed to do that. In fact, according to the genetics test my current neurologist had me take, I was never supposed to that.

Pharmacogenetic testing results

My current neurologist had me take a pharmacogenetic test about six months ago. A pharmacogenetic test is intended to personalize medicine and make treatment safer and more effective by taking into account how your personal genetics interact with a variety of specific medications. Included in my test were nearly all of the medications I’ve been prescribed over the years for migraine (and anxiety/panic attacks) including SSRIs, SNRIs, TCAs, anticonvulsants, NSAIDs, opioids, benzodiazepines, triptans, and ergot derivatives.

The results were fascinating. The test indicated that I have a lower response rate to almost every SSRI available, which matched my personal experiences of never experiencing any relief from drugs like fluoxetine or sertraline despite having tried them all. It also indicated that I would have issues with topiramate, which I absolutely did, and that I am an ultra-rapid metabolizer of both caffeine and codeine, which means I need more than other people do of each in order to feel a therapeutic effect. Finally, it said I had a substantially increased risk of toxicity and severe side effects from ibuprofen.

While none of the others surprised me, and many (like the needing more codeine for relief) actually validated my personal experiences, this last one floored me.

I had never had any issues with ibuprofen, and I’d been taking it for years. It didn’t always work, and I always made sure to take it with food, but I hadn’t expected it to be something I should avoid for fear of toxicity. While some people may have continued to take it, I didn’t. After all, the other results were too accurate, and I had recently studied its potential to cause severe bleeding. Instead, I switched to naproxen, which my results said was okay, and I continue to pray for the day that CAMBIA, which works wonders and is on my gene-approved list, becomes more affordable.

What about you? Have any of you taken a pharmacogenetic test? Would you?

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I heard of genetic testing a couple years ago. With my experience with medicine, in general and especially for mental health, it was quite exciting to hear. This is the first time I have heard of it being used outside of studies though.

Figuring out interactions alone is difficult but it is also hard to find the right medicine to treat a certain condition. The psychotropics are especially difficult to find the right one to work. I wish it was more common, thus more accessible and a bit cheaper for everyone to have.

I agree. I would love to see this become more accessible. It was particularly interesting to see that the report also indicated increased changes of interaction between certain medications based on my genetics. That is wonderful information to have before combining meds!

I just had my DNA mapped while going through gut related problems. Between diarrhea and daily migraines I was searching for answers. This was a new MD who practises Functional Medicine which looks at disease at the cellular level. My DNA showed that my liver was lousy at detoxification. In particular acetaminophen. I’m 61 years old and have had daily migraines for 40 years. Before the triptans came out I was taking 30-35 Tylenol #1’s a day. These are available over the counter here in Canada so it wasn’t hard to get. No surprise I ended up with Liver disease. I was very lucky when I was told about a product called Immunocal which provides the third Triptide which when consumed allows your body to create Glutathione. This is the bodies master antioxidant. It saved my liver and my life. Forty years ago I had no idea that my DNA preconditioned me to not be able to detoxify myself well. I now know that alcohol, caffeine and acetaminophen must all be used as little as possible. As was mentioned above , even after I started using triptans I still used Tylenol #1″ because they still worked on minor pain. So the doctor has now advised me that I need to up my B vitamins in order better support the other parts of my detoxification system. He used a lot of words I had never heard before. This is a brave new world of Medicine. The goal is to reduce inflammation. THis include Migraines. So far I have been following a Paleo diet. The big change is absolutely no sugar. I have gone three weeks without a Migraine which is a huge record for me. Not enough time has passed to make any definitive statements but this is the most promising road I have been down after searching for 40 years. Best of luck to all my fellow travellers.

I’m so glad you found a doctor who could provide such valuable information! That’s key to managing conditions and illnesses, and it sounds like you’ve experienced positive changes based on that info. That’s wonderful! Thank you for sharing with us.

I would LOVE to take one of these tests. I’m the exact opposite: ibuprofen doesn’t work for me no matter how much I take it so I’ve deemed it useless and have even turned away other meds that involved ibuprofen components (because for some reason my doctors act like medications can’t be messed with and the ibuprofen can’t be taken out, which I’m pretty sure is wrong because I can’t have caffeine and they take THAT out so..) but can pop acetaminophen every once in a while. I’m paranoid about most meds so this test would be amazing in general, honestly.